Britain’s long-term sickness problem is chronic – but the over-50s aren’t to blame

Sarah has tried many times to find a job that is right for her. The 20-year-old, who lives with her father in Birmingham, has worked as a cleaner at a GP practice, a carer for the elderly and has done housekeeping and kitchen roles at a hotel. 

“Starting a new job is traumatic, even under a lot of medication. It’s a week of insomnia, not eating and being in distress and I usually quit a few months later,” she says. 

Since the age of nine Sarah has suffered from severe anxiety and depression. Her condition has left her unable to work for the past year.

“A bad day for me feels like a dragged-out nightmare. Trying not to be sick and cry, trying to hear past my own thoughts,” she says. “I usually end up lying on the floor, trying to breathe and ground myself.” 

Sarah’s struggles with her mental health mean that even though she loves reading, learning languages and painting, she was unable to complete secondary school. When she was 13, the thought of going to school made her so anxious she tried to take her own life.

“I get overwhelmed by very small things and interactions, so the thought of exams is just terrifying. [That’s] why I didn’t want to continue my education, even if I had plenty of friends and was never really bullied,” she says. 

The Government deems her condition so debilitating that she is classed as having “limited capacity to work”, entitling her to long-term sickness benefits. 

Across Britain, stories of young people like Sarah are increasingly common. New figures from NHS England show that one in five 8- to 25-year olds had a probable mental health disorder in 2023.

Meanwhile, recent Office for National Statistics (ONS) data show that more than 2.7 million 18-to-34-year olds are classed as economically inactive, meaning they are not working or looking for a job.  

It marks an increase of 92,000 from before the pandemic. But the numbers, which include those inactive because of higher education, hide a worrying trend.

In the past decade, the number of 18-to-24-year-olds who are economically inactive due to ill health has roughly doubled to 185,000. Among those aged 25 to 34 the figure is up 133,000 to 330,000. For years the rise had been gradual until Covid hit. Then it soared. 

Economists, politicians and academics have for more than a year tried to explain why the UK is one of the only rich countries where fewer people are employed than before the pandemic. It is a problem that has been blamed for making inflation worse, as businesses struggle to find enough workers, and for fuelling a ballooning benefits bill. 

Experts have for the most part focused on older people and explored why so many over-50s have disappeared from the workforce, as they are the biggest group in absolute numbers. 

But figures from the Office for National Statistics show that in relative terms, long-term sickness has risen far faster among young people. Since the pandemic, 37 per cent more 16 to 34-year-olds are too sick to work, compared with 16 per cent more 50 to 64-year-olds.

Economists warn that this often-overlooked rise risks having wide-reaching implications for public finances, as growing numbers are forced to rely on the state. 

“We know that any period of youth worklessness has a scarring impact on future wages, but also it increases people’s chances of being out of work in the future,” says Louise Murphy from the Resolution Foundation.  

Older people who are forced to stop working from sickness most commonly report suffering from physical pains. But for young people like Sarah, by far the greatest driver is their mind working against them rather than their body. 

People suffering from mental health conditions have much lower employment rates than the wider population, at 51 per cent compared with 75 per cent. While these numbers have improved over the past decade, they suggest that a sharp rise in mental illness among young people will likely lead to more adults being out of work later.

The number of successful new claims from people aged 16 to 34 for personal independence payments for mental health rose from to 5,288 a month in 2022, up from 2,033 in 2021 – an increase of 160 per cent. Only a fraction of young people unable to work for health reasons claim benefits, however, says Murphy. But they are likely to stay out of work for far longer than their peers.

“Over three-quarters of young people who are inactive due to ill health have been workless for at least two years. That compares with just a quarter of those who are unemployed,” Murphy says. 

Experts are still not fully sure why so many more young people suffer from conditions like anxiety and depression. 

“It seems to be a combination of factors. We can’t fully explain it,” says Dr Elaine Lockhart, chair of the child and adolescent faculty at the Royal College of Psychiatrists. 

“Before the pandemic, we were seeing that the incidence of probable mental health disorders increased quite significantly between 2000 and 2017.”

Illustrating how rapidly mental health among young people has deteriorated more recently, new NHS England figures show the share of 17- to 19-year-olds with eating disorders has risen to 12.5pc this year, from only 0.8pc in 2017.

It means that one in eight are now affected rather than fewer than one in a hundred.

Meanwhile, close to one in four 17 to 19-year-olds now have a probable mental health condition, according to the NHS, up from only one in 10 in 2017. Greater openness around mental health only partially explains the increase, according to Dr Lockhart, meaning there are genuinely more who are struggling. 

Economic changes like rising inequality over the past decades may have played a part, she believes. In the past 15 years, the economy has suffered a multitude of once-in-a-generation shocks such as the financial crisis, the pandemic and the war in Ukraine. 

For working families, the impact has been a decade of lost real wage growth squeezing budgets while house and rental prices have soared. 

“[Young people] are hugely impacted by the health, wellbeing and functioning of the parents or carers looking after them,” Dr Lockhart says. 

Another big change is the rise of social media. “If you are really struggling, and you’re looking for very unhelpful content, you will find it there,” she adds.

Against these gradual economic and technological changes came the pandemic, which appears to have sped up considerably the deterioration in mental health across society. For some young people, the impact could haunt them for their entire working lives. 

At the children’s hospital Dr Lockhart worked at before and during the pandemic, she went from seeing five young people with severe eating disorders in a year to five every month. More children were also presenting in crisis “with self-harm, suicidal thoughts and planning,” she says.  

“The loss of the structure, the routine and predictability, the kind of thing children and young people will tell you is boring, it’s actually what they thrive on,” she says. “The lockdowns, the school closures and the curtailment of all the support that children get has had an ongoing impact. We’re still seeing the effect of it.”

Separately from the mental health crisis, there has also been a significant uptick in children receiving health-related benefits. Over the past two decades, the number of children aged nine to 13 receiving disability payments has nearly tripled to 190,000 up from 70,000 in 2002.

This has happened because of a rise in ADHD and autism diagnoses, mostly in boys. It means that one in 14 children of this age at any time receive benefits, up from around one in 40. 

Spending on disability benefits for children is expected to double in a decade to £3.6bn in the year to March 2024. This is another development that has challenging long-term implications for public finances, says Tom Waters from the Institute for Fiscal Studies (IFS).

“Getting on to disability benefits has a somewhat persistent impact,” he says. 

“If the increase we see in children persists into adulthood, for many of them you could be looking at decades, perhaps even their whole working lives, of being on disability benefits, which when added up is going to be a large sum of money.” 

Dr Lockhart believes that the number of children with these types of neurobehavioural conditions has remained stable. GPs, teachers and parents have simply become better at identifying them. 

“I think it’s probably two things; I think awareness of benefits and recognition of these conditions,” she says.

Lots of children with ADHD and autism will grow up and do well, both socially and at work.

“But when they’re really impaired, if they don’t have the right support and treatment, then it affects their ability to learn to get into work to sustain meaningful relationships,” she says.

Getting the right support early both for the child and for the parents can make all the difference, according to Dr Lockhart. 

Many of the young adolescents with such conditions that she works with have still not recovered to where they were before Covid because of the loss of routine, she warns. Many were also diagnosed later than they otherwise would have been due to closed schools and waiting lists. It means these young people may struggle more in education and work for years to come because of the pandemic.

In Liverpool, youth workers Tony Hewitt and Tracey Ainsworth, from the Prince’s Trust, have seen the recent years’ challenges up close. 

They try to help young people who are outside the workforce find their way back into education or work. The people they meet range from teenagers growing up in severe poverty to middle-class graduates.

Hewitt and Ainsworth have both worked in the sector for more than 25 years. When asked what the biggest change they have noticed in the young people over that time has been, both immediately say “mental health”.

“Since lockdown, there’s loads more young people coming through our doors with a range of mental health issues. The majority of them are around anxiety – just like that dread of meeting someone new, coming out of their room, coming out of the house, even getting them into our buildings,” Hewitt says.  

“Sometimes a member of our staff has to go and collect them from the train station because they haven’t got the confidence to walk over, even if we’re only five minutes away.”

Most of the people they meet lack confidence, believe they have no skills and struggle to get the first work experience they need in the jobs market. 

There are also some who struggle with “learned behaviour from the home” and don’t see the point in having a job, says Ainsworth. 

“All they know is benefits and how to survive on that. Their parents and their grandparents have never worked,” she says. “They don’t see that it gives you that self-confidence, that self-belief and self-worth in society. So that’s where we try to work with them.”

Some also find themselves worse off by being on the minimum wage than on Universal Credit, as they may lose access to free or subsidised housing. Hewitt and Ainsworth try to teach them to think about career progression beyond the first job. 

But researchers say that young people who are economically inactive from sickness rather than being unemployed often fall outside such patterns of being from workless families.

They are just as often represented among the middle classes in “more affluent leafy rural areas” as in places with high deprivation, according to Murphy. 

For Sarah, both of her parents suffer from anxiety too but are able to work. Her father is in scaffolding and her mother has her own business. 

Like Dr Lockhart, Hewitt and Ainsworth also highlight the impact of Covid disruption on education. 

“We’ve got a girl who is coming on the next course in November. We’ve had three meetings in her house. She won’t leave the house because she hasn’t been to school since she was about 12-13,” they explain.

In schools, pupil absences are still more than 60 per cent higher than before the pandemic. Research shows that a record proportion of secondary pupils missed at least a month of school in the last academic year. 

“If you look at attendance statistics across the week nationally, there is a significant dip on Fridays. I don’t think that’s a coincidence,” says Manny Botwe, head teacher of Tytherington School in Macclesfield. 

Children who missed more than 10 per cent of school are vastly overrepresented among those classed as NEET – meaning not in education, employment or training. Persistently absent pupils are also more than three times as likely to commit an offence by age 17 than those attending school, according to separate Government research. 

The Centre for Social Justice has warned that the spike in absences risks creating 9,000 extra young offenders by 2027, costing the taxpayer as much as £100m a year.

The patterns that people like Botwe, Hewitt, Ainsworth and Dr Lockhart see suggest the rise in inactivity could well get worse. They speak of a generation of young people who were already getting sicker before the pandemic, but who have since slipped out of their routines and retreated into bedrooms and behind screens.

The staggering rise in young people finding themselves in this situation presents a considerable challenge for the Government. Health and disability benefits for children are set to more than double in the six years to £5.3bn by 2027-28.  Among working-age adults, they are projected to rise by 73 per cent over the same period to £68.7bn. Together, these increases will lead to an extra cost of around £32bn annually before the end of this decade. 

So far, attempts to move people off disability and sickness benefits have mostly proved futile, says Waters. 

“It’s a very difficult set of trade-offs for the Government. They can tighten eligibility, which has historically proven difficult and will mean reducing support for a fairly vulnerable group of people, or they can accept rising disability benefit spending and have to increase taxes or cut spending elsewhere.”

It comes at a time when there is a plethora of demands on public spending and the tax burden is at a 70-year high. 

Former Bank of England chief economist Andy Haldane recently warned of working age people aged 35 to 50 being a “sandwich” generation that faces higher taxes because of rising inactivity among young and old. 

Experts and those working with young people stress that the best way to save money is by intervening early and linking up services. Half of all mental health problems manifest by age 14, while three-quarters are apparent by the age of 24.

“If you ask the Government what it is doing to make sure that young people are engaged in education and employment, it could probably give you a very, very long list. But it’s a very long list; it’s not a system. There’s lots of initiatives and not enough strategy,” says Stephen Evans from the Learning and Work Institute.

The Government is spending £2bn helping those with disabilities and long-term health conditions into work. A Department for Work and Pensions spokesman said: “Our flagship Universal Support scheme is placing these people in a job before giving them extensive in-work support, whilst our Talking Therapies programme is combining the expertise of therapists and employment advisers to give those with mental health conditions the support they need to find work tailored to them.”

But Dr Lockhart is “frustrated”. “This isn’t too difficult to address if we could go about it the right way,” she says. “We have good evidence-based treatments for anxiety, depression and ADHD. The earlier you intervene, the better the outcome.”

This is echoed by Ainsworth and Hewitt. The most common mental health problem they see is anxiety, but with the right intervention it can improve rapidly. “It’s probably one of the easiest things to fix,” Hewitt says.

Of course, for those in the thick of it like Sarah, it will not feel that way. Not working “is saving my life and my mental health,” she says.